Provider Demographics
NPI:1972201861
Name:BROCKWAY, NATALI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NATALI
Middle Name:
Last Name:BROCKWAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MRS
Other - First Name:NATALI
Other - Middle Name:JO
Other - Last Name:GOODSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1351 ANDY ST APT 202
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4413
Mailing Address - Country:US
Mailing Address - Phone:903-669-4560
Mailing Address - Fax:
Practice Address - Street 1:100 E FERGUSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-5759
Practice Address - Country:US
Practice Address - Phone:903-669-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1372916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist